Healthcare Provider Details

I. General information

NPI: 1689133209
Provider Name (Legal Business Name): JEANNE LOUISE FRASIER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 EAGLERIDGE CIR
PUEBLO CO
81008-2344
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7563
  • Fax: 719-595-7907
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: